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Resident's Forum
June 2012

Massive TransfusionAn Evidence-Based Review of Recent Developments

Author Affiliations

Author Affiliations: Division of General Surgery and Trauma, Department of Surgery (Drs Neal, Kautza, Forsythe, Marshall, and Sperry), and Division of Transfusion Medicine, Department of Pathology, The Institute for Transfusion Medicine (Dr Raval), University of Pittsburgh Medical Center, and Department of Surgery, University of Pittsburgh School of Medicine (Ms Marsh and Mr Marino), Pittsburgh, Pennsylvania.

Arch Surg. 2012;147(6):563-571. doi:10.1001/archsurg.2011.2212

The design and implementation of massive transfusion protocols with ratio-based transfusion of blood and blood products are important and active areas of investigation. A significant yet controversial body of literature exists to support the use of hemostatic resuscitation in massive transfusion and new data to support the use of adjuncts, such as recombinant factor VIIa and tranexamic acid. We review the developments in massive transfusion research during the past 5 years, including protocol implementation, hemostatic resuscitation, the use of tranexamic acid, and goal-directed therapy for coagulopathy. Furthermore, we provide a level of evidence analysis of the data surrounding the use of component therapy and recombinant factor VIIa in massive transfusion, summary recommendations for the various agents of resuscitation, and new methods of goal-directed therapy.